MEDICARE: SUSAN SMITH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	803	NV

General Provider Information

NPI Number	:	1720006349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN SMITH PA-C

Provider Business Mailing Address
First Line	:	9097 W POST RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2411
Country	:	US
Telephone Number	:	702-430-5333
Fax Number	:	702-430-5335

Provider Business Practice Location Address
First Line	:	9097 W POST RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2411
Country	:	US
Telephone Number	:	702-430-5333
Fax Number	:	702-430-5335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/11/2025

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Directions to “ SUSAN SMITH PA-C” Practice Location

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